Citizens Fire Academy Application

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Spring 2020 application

Please correct the field(s) marked in red below:

Name:
 *
Street Address:
 *
City:
 *
State:
 *
Zip:
 *
Home Phone:
 *
Cell Phone:
Employer:
E-mail address:
How long have you lived in Brentwood:
Date of birth: (mm/dd/yyyy)
Sex:
 *
Sex:
Shirt Size:
 *
Shirt Size:
Why do you want to attend the Citizens Fire Academy:
How did you hear about the Citizens Fire Academy:
Have you ever been convicted of a felony? 
 *
Have you ever been convicted of a felony?
Have you ever been convicted of a felony involving moral turpitude?
 *
Have you ever been convicted of a felony involving moral turpitude?
Do you have any severe physical limitations which would hinder you from engaging in activities associated with the Citizens Fire Academy:
 *
Do you have any severe physical limitations which would hinder you from engaging in activities associated with the Citizens Fire Academy:
I am willing to undergo a minimum background investigation by the City of Brentwood Police Department due to the sensitivity and nature of some of the information that will be covered during the course of training.
 *
I am willing to undergo a minimum background investigation by the City of Brentwood Police Department due to the sensitivity and nature of some of the information that will be covered during the course of training.
  1. To receive a copy of your submission, please fill out your email address below and submit.